Pleural effusion natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]
Overview
Complications of pleural effusion can result from the disease itself or from complication of treatment procedure. These include; empyema[1][2], Pneumothorax[3][4][5][6], Reexpansion pulmonary edema[7][8] and Postcardiac injury syndrome.[9][10][11]
Natural History
The symptoms of pleural effusion when left without treatment, the patient will develop worsening symptoms of respiratory distress with increasing accumulation of pleural fluid.
Complications
Complications of pleural effusion can result from the disease itself or from complication of treatment procedure.
- Pleural fluid can be secondarily infected and may turn into an abscess or empyema, which will need to be drained with a chest tube.[1][2]
- Pneumothorax can be a complication of thoracentesis procedure.[3][4][5][6]
- Reexpansion pulmonary edema as a complication of therapeutic thoracentesis[7][8]
- Postcardiac injury syndrome (PCIS)[9][10][11]
- A general term for fever and pleuropericardial disease days or months after cardiac injury (myocardial infarction or surgery).
- Typically present two to three weeks post op.
- Chest pain
- Pericardial rub
- Fever
- Leukocytosis
- Elevated erythrocyte sedimentation rate (ESR)
- Variable combinations of pulmonary effusions and infiltrates.
Prognosis
The prognosis of pleural effusion depends upon the underlying disease. High expression of E-cadherin in pleural effusion cells predicts better prognosis in lung adenocarcinoma patients.[12] Imbalance of regulatory T cells/T helper IL-17-producing cells in malignant pleural effusion partially predicts poor prognosis. Also, a high ratio of regulatory T/Th17 cells in malignant pleural effusion highly correlates with poor survival.[13]
References
- ↑ 1.0 1.1 Molander V, Diakopoulou M, Orre L, Ferrara G (2013). "Chronic empyema: importance of preventing complications in the management of pleural effusions". BMJ Case Rep. 2013. doi:10.1136/bcr-2013-200454. PMC 3762540. PMID 23946529.
- ↑ 2.0 2.1 Sziklavari Z, Neu R, Hofmann HS, Ried M (2015). "[Persistent pleural effusion following thoracic surgery]". Chirurg. 86 (5): 432–6. doi:10.1007/s00104-014-2863-2. PMID 25920472.
- ↑ 3.0 3.1 Josephson T, Nordenskjold CA, Larsson J, Rosenberg LU, Kaijser M (2009). "Amount drained at ultrasound-guided thoracentesis and risk of pneumothorax". Acta Radiol. 50 (1): 42–7. doi:10.1080/02841850802590460. PMID 19052935.
- ↑ 4.0 4.1 Barnes TW, Morgenthaler TI, Olson EJ, Hesley GK, Decker PA, Ryu JH (2005). "Sonographically guided thoracentesis and rate of pneumothorax". J Clin Ultrasound. 33 (9): 442–6. doi:10.1002/jcu.20163. PMID 16281263.
- ↑ 5.0 5.1 Ponrartana S, Laberge JM, Kerlan RK, Wilson MW, Gordon RL (2005). "Management of patients with "ex vacuo" pneumothorax after thoracentesis". Acad Radiol. 12 (8): 980–6. doi:10.1016/j.acra.2005.04.013. PMID 16087092.
- ↑ 6.0 6.1 Díaz G, Castro DJ, Pérez-Rodríguez E (2000). "Factors contributing to pneumothorax after thoracentesis". Chest. 117 (2): 608–9. PMID 10669716.
- ↑ 7.0 7.1 Doelken P, Huggins JT, Pastis NJ, Sahn SA (2004). "Pleural manometry: technique and clinical implications". Chest. 126 (6): 1764–9. doi:10.1378/chest.126.6.1764. PMID 15596671.
- ↑ 8.0 8.1 Okubo T, Kawada M, Suzuki Y, Kawarada Y, Kitashiro S, Okushiba S (2013). "[Reexpansion pulmonary edema following thoracentesis]". Kyobu Geka. 66 (6): 456–9. PMID 23917048.
- ↑ 9.0 9.1 Namba R, Yamamoto Y, Nawa T, Endo K (2009). "[A case of postcardiac injury syndrome with repeated pleuritis after blunt chest trauma]". Nihon Kokyuki Gakkai Zasshi. 47 (12): 1161–5. PMID 20058698.
- ↑ 10.0 10.1 Remetz MS, Cleman MW, Cabin HS (1989). "Pulmonary and pleural complications of cardiac disease". Clin Chest Med. 10 (4): 545–92. PMID 2689066.
- ↑ 11.0 11.1 Stelzner TJ, King TE, Antony VB, Sahn SA (1983). "The pleuropulmonary manifestations of the postcardiac injury syndrome". Chest. 84 (4): 383–7. PMID 6617272.
- ↑ Zhao C, Li X, Su C, Li J, Cheng N, Ren S; et al. (2015). "High expression of E-cadherin in pleural effusion cells predicts better prognosis in lung adenocarcinoma patients". Int J Clin Exp Pathol. 8 (3): 3104–9. PMC 4440133. PMID 26045824.
- ↑ Yang G, Li H, Yao Y, Xu F, Bao Z, Zhou J (2015). "Treg/Th17 imbalance in malignant pleural effusion partially predicts poor prognosis". Oncol Rep. 33 (1): 478–84. doi:10.3892/or.2014.3576. PMID 25371165.